Lichen planus

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Lichen planus: This common skin disease often develops on the wrist.

Lichen planus: Overview

Many people get lichen (LY-kin) planus (PLAN-us). This disease can develop on one or several parts of the body. It can appear on the skin or inside the mouth. Sometimes, it appears in both places. Lichen planus can even change the way a person’s fingernails or toenails look. It also can appear on the genitals or a person’s scalp.

Lichen planus is not contagious. You cannot get this disease from someone else, and you cannot give it to anyone. Lichen planus is not a type of cancer.

Lichen planus: When bumps appear on the skin, the bumps are often shiny, firm, and reddish purple.

Lichen planus: Signs and symptoms

The signs and symptoms of lichen planus depend on where it appears on the body.

Skin

On the skin, lichen planus often causes bumps that are shiny, firm, and reddish purple. Sometimes the bumps have tiny white lines running through them. These lines are called Wickham’s striae.

Most people get a few bumps. Some people get many bumps, which can appear on different parts of the body. The most common places for these bumps to appear are the wrists, lower back, and ankles, but they can appear anywhere on the skin, including the genitals.

On the legs, the bumps tend to be darker.

Lichen planus: Some people get many bumps on their skin.
New bumps may appear as older bumps clear.

When lichen planus develops on the skin, a person can have the following:

Thick patches of rough, scaly skin. If bumps continue to appear in the same place, thick patches of rough, scaly skin can form. These patches develop with time and are most common on the shins and around the ankles.

Itch. Sometimes the bumps and patches itch. The thick patches are most likely to itch.

Blisters. These are rare.

Pain, especially on the genitals. The skin can be bright red and raw. Open sores can appear. These can make sex painful or impossible.

When lichen planus appears inside the mouth, it most commonly occurs on the insides of the cheeks. It also can appear on the tongue, lips, and gums. Inside your mouth, you may have:

Patches of tiny white dots and lines that can look like lace.

Redness and swelling.

Peeling on the gums.

Painful sores (can hurt or burn).

Lichen planus: On a fingernail or toenail, lichen planus can lead to nail loss. Nails

When lichen planus appears on the nails, it often appears on just a few nails. Sometimes it appears on all of the nails on a hand or foot. You may see:

Ridges or grooves on the nails.

Splitting or thinning.

Loss of nails (can be temporary or permanent).

Scalp (lichen planopilaris)

It is rare, but this disease can develop on the scalp. If it does, you may have the following on your scalp:

Redness and irritation.

Tiny bumps.

Thinning hair or patches of hair loss.

Scars (appear slowly).

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Lichen planus: Who gets and causes

Who gets lichen planus?

Anyone can get lichen planus. It is most common in middle-aged adults. Women get lichen planus in their mouths more often than men do.

What causes lichen planus?

What causes most cases of lichen planus remains unclear. One theory is that lichen planus is an autoimmune disease. This means the person’s immune system reacts as though the skin and other parts of the body are foreign. When this happens, the body starts to attack itself. To find out whether lichen planus is an autoimmune disease, we need more research.

We do know the following:

Some medicines can cause a rash that looks like lichen planus. These medicines include diuretics (treatment for high blood pressure and heart disease) and medicine taken to prevent malaria. Be sure to tell your dermatologist about every medicine that you take.

In the mouth, a metal filling may be the cause. This is rare, but it can happen. If this is the cause, replacing the metal filling with a non-metal filling will get rid of the lichen planus.

A rare type of lichen planus, familial bullous lichen planus, runs in families. Other forms of lichen planus do not seem to run in families.

There may be a link between lichen planus and infection with the hepatitis C virus. Many people with hepatitis C also have lichen planus. Your dermatologist may check to see whether you have this virus.

Lichen planus: Diagnosis and treatment

How do dermatologists diagnose lichen planus?

A dermatologist often can tell whether you have lichen planus by looking at your skin, nails, and mouth. To make sure that you have lichen planus, a dermatologist may remove a bit of skin. This skin will be examined under a microscope to make sure. Your dermatologist may call this a biopsy. Sometimes, you may need blood tests to rule out other diseases.

Dentists often find lichen planus in the mouth during a checkup.

How do dermatologists treat lichen planus?

There is no cure for lichen planus. It often goes away on its own. If symptoms are bothersome, treatment often brings relief and may speed healing. Treatment for the skin may include:

Antihistamines: Pills that help alleviate itching.

Topical (applied to the skin) corticosteroid: Cream or ointment to reduce swelling and redness.

Corticosteroid: Pills (such as prednisone) or shots can help when lichen planus lasts a long time or a patient has many bumps or painful sores.

PUVA therapy: A type of light treatment that can help clear the skin.

Retinoic acid: Applied to the skin or given as a pill to clear the skin.

Tacrolimus ointment or pimecrolimus cream: Used to treat another skin problem, eczema.

Ask your dermatologist about possible side effects (health problems that can result from the medicines).

When lichen planus develops in the mouth, it often does not cause pain or other symptoms. If this is the case, treatment may not be necessary. When lichen planus causes pain, burning, redness, blisters, sores, or ulcers, it can be treated. Some medicine is applied to the sores. Other medicine comes in pill form.

Any mouth disease can lead to gum disease. It is important to brush and floss as directed by your dentist. You also should keep all appointments with your dentist and get cleanings at least twice a year.

Outcome

Many cases of skin lichen planus go away within 2 years. About 1 in 5 people will have a second outbreak. In some people, the skin problem may come and go for years.

As lichen planus heals, it often leaves dark brown spots on the skin. Like the bumps, these spots may fade without treatment. If they do not go away, dermatologists can lighten the spots with creams, lasers, or other treatments.

Lichen planus in the mouth often lasts longer than lichen planus on the skin. In the mouth, it can be harder to treat.

Lichen planus: Tips for managing

You may be able to stop lichen planus from getting worse by doing the following:

Skin

Limit stress. Stress can make lichen planus worse.

Try not to scratch. Covering the rash with a bandage can help.

Calm the itch. Applying a cool cloth or using an oatmeal bath treatment can help. You can buy an oatmeal bath treatment at a drugstore.

Try not to injure your skin. A skin injury can cause an outbreak where the skin was injured.

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Mouth

If you have lichen planus in your mouth, you may have a higher risk of getting cancer in your mouth (oral cancer). Here are some things you can do to reduce that risk:

Stop smoking, chewing tobacco, and drinking alcohol.

Get a screening for oral cancer every 6 to 12 months from your dentist or dermatologist.

Brush twice a day.

Floss daily.

Visit your dentist twice a year for a checkup and cleaning.

Stop consuming foods and beverages that can worsen lichen planus in the mouth. The culprits are spicy foods, citrus fruits and juices (such as oranges and grapefruits), tomatoes and foods made with tomatoes (such as salsa, pasta sauces, and ketchup), snacks that are crispy and salty (such as corn chips), drinks that contain caffeine (such as coffee, tea, and cola).

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Scalp and nails

If you have hair loss or nail problems, you should see a dermatologist. Without treatment, these may not regrow.

Genitals

If you have red areas or open sores, you need treatment. Dermatologists treat lichen planus on the genitals.